SSRC Library

The SSRC Library allows visitors to access materials related to self-sufficiency programs, practice and research. Visitors can view common search terms, conduct a keyword search or create a custom search using any combination of the filters at the left side of this page. To conduct a keyword search, type a term or combination of terms into the search box below, select whether you want to search the exact phrase or the words in any order, and click on the blue button to the right of the search box to view relevant results.

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Importance Trauma is a leading cause of death and disability for patients of all ages, many of whom are also among the most likely to be uninsured. Passage of the Patient Protection and Affordable Care Act was intended to improve access to care through improvements in insurance. However, despite nationally reported changes in the payer mix of patients, the extent of the law’s impact on insurance coverage among trauma patients is unknown, as is its success in improving trauma outcomes and promoting increased access to rehabilitation.

Objective To use rigorous quasi-experimental regression techniques to assess the extent of changes in insurance coverage, outcomes, and discharge to rehabilitation among adult trauma patients before and after Medicaid expansion and implementation of the remainder of the Patient Protection and Affordable Care Act.

Importance Trauma is a leading cause of death and disability for patients of all ages, many of whom are also among the most likely to be uninsured. Passage of the Patient Protection and Affordable Care Act was intended to improve access to care through improvements in insurance. However, despite nationally reported changes in the payer mix of patients, the extent of the law’s impact on insurance coverage among trauma patients is unknown, as is its success in improving trauma outcomes and promoting increased access to rehabilitation.

Objective To use rigorous quasi-experimental regression techniques to assess the extent of changes in insurance coverage, outcomes, and discharge to rehabilitation among adult trauma patients before and after Medicaid expansion and implementation of the remainder of the Patient Protection and Affordable Care Act.

Main Outcomes and Measures Changes in insurance coverage, outcomes (mortality, morbidity, failure to rescue, and length of stay), and discharge to rehabilitation.

Results A total of 283 878 patients from Medicaid expansion states and 285 851 patients from nonexpansion states were included (mean age [SD], 41.9 [14.1] years; 206 698 [36.3%] women). Adults with injuries in expansion states experienced a 13.7 percentage point increase in discharge to rehabilitation (95% CI, 7.0-7.8; baseline: 14.7%) that persisted across inpatient rehabilitation facilities (4.5 percentage points), home health agencies (2.9 percentage points), and skilled nursing facilities (1.0 percentage points). There was also a 2.6 percentage point drop in failure to rescue and a 0.84-day increase in length of stay. Rehabilitation changes were most pronounced among patients eligible for rehabilitation coverage under the 2-midnight (8.4 percentage points) and 60% (10.2 percentage points) Medicaid payment rules. Medicaid expansion increased rehabilitation access for patients with the most severe injuries and conditions requiring postdischarge care (eg, pelvic fracture). It mitigated race/ethnicity-, age-, and sex-based disparities in which patients use rehabilitation.

Conclusions and relevance This multistate assessment demonstrated significant changes in insurance coverage and discharge to rehabilitation among adult trauma patients that were greater in Medicaid expansion than nonexpansion states. By targeting subgroups of the trauma population most likely to be uninsured, rehabilitation gains associated with Medicaid have the potential to improve survival and functional outcomes for more than 60 000 additional adult trauma patients nationally in expansion states. (Author abstract)

Work-related requirements—such as employment, job search, job training, or community engagement activities—are currently a condition of eligibility for some safety net programs. Temporary Assistance for Needy Families (TANF), the Supplemental Nutrition Assistance Program (SNAP), housing assistance and Medicaid each include work-related requirements in some states or localities for some beneficiaries. Recent proposals would expand or introduce new work requirements in these and other safety net programs, which offer vital supports for families to meet their basic needs.

For parents, meeting work requirements to gain or maintain eligibility for safety net programs and access to vital supports is not as straightforward as simply engaging in the required work activities. Parents must not only understand what the requirements are, but be able to access the necessary training and supports to meet the requirements and document their compliance. If they qualify for an exemption, they must learn how to document this as well. Agencies administering safety net programs must be able...

Work-related requirements—such as employment, job search, job training, or community engagement activities—are currently a condition of eligibility for some safety net programs. Temporary Assistance for Needy Families (TANF), the Supplemental Nutrition Assistance Program (SNAP), housing assistance and Medicaid each include work-related requirements in some states or localities for some beneficiaries. Recent proposals would expand or introduce new work requirements in these and other safety net programs, which offer vital supports for families to meet their basic needs.

For parents, meeting work requirements to gain or maintain eligibility for safety net programs and access to vital supports is not as straightforward as simply engaging in the required work activities. Parents must not only understand what the requirements are, but be able to access the necessary training and supports to meet the requirements and document their compliance. If they qualify for an exemption, they must learn how to document this as well. Agencies administering safety net programs must be able to efficiently process each case.

This report illustrates and explores the complex pathways parents who are subject to work requirements must navigate to maintain their access to the safety net. Some pathways may lead families to maintain their access to benefits, while others could lead them to lose access to benefits for which they are still eligible. (Edited author abstract)

This set of selections focuses on adult obesity. SSRC Selections highlight research, evaluation reports, and other publications that inform the field about key issues in, and effective practices for, fostering economic self-sufficiency.

This set of selections focuses on adult obesity. SSRC Selections highlight research, evaluation reports, and other publications that inform the field about key issues in, and effective practices for, fostering economic self-sufficiency.

This paper studies the relationship between local opioid prescription rates and labor market outcomes. We improve the joint measurement of labor market outcomes and prescription rates in the rural areas where nearly 30 percent of the US population lives. We find that increasing the local prescription rate by 10 percent decreases the prime-age employment rate by 0.50 percentage points for men and 0.17 percentage points for women. This effect is larger for white men with less than a BA (0.70 percentage points) and largest for minority men with less than a BA (1.01 percentage points). Geography is an obstacle to giving a causal interpretation to these results, especially since they were estimated in the midst of a large recession and recovery that generated considerable cross-sectional variation in local economic performance. We show that our results are not sensitive to most approaches to controlling for places experiencing either contemporaneous labor market shocks or persistently weak labor market conditions. We also present evidence on reverse causality, finding that a short-...

This paper studies the relationship between local opioid prescription rates and labor market outcomes. We improve the joint measurement of labor market outcomes and prescription rates in the rural areas where nearly 30 percent of the US population lives. We find that increasing the local prescription rate by 10 percent decreases the prime-age employment rate by 0.50 percentage points for men and 0.17 percentage points for women. This effect is larger for white men with less than a BA (0.70 percentage points) and largest for minority men with less than a BA (1.01 percentage points). Geography is an obstacle to giving a causal interpretation to these results, especially since they were estimated in the midst of a large recession and recovery that generated considerable cross-sectional variation in local economic performance. We show that our results are not sensitive to most approaches to controlling for places experiencing either contemporaneous labor market shocks or persistently weak labor market conditions. We also present evidence on reverse causality, finding that a short-term unemployment shock did not increase the share of people abusing prescription opioids. Our estimates imply that prescription opioids can account for 44 percent of the realized national decrease in men’s labor force participation between 2001 and 2015. (Author abstract)

We argue in Part 1 of this paper that maternal depression is an under-acknowledged factor in the intergenerational transmission of poverty, and lack of economic mobility. Specifically, we show that:

I. Poverty increases the risk of maternal depression;

II. Maternal depression can weaken attachment;

III. Weaker attachment can impair child development;

IV. Slower development can damage child outcomes; and

V. Worse child outcomes can increase the risk of future poverty.

Since our focus here is on the role of the mental health of caregivers in the very early years, we spend more time on these particular links in the chain. The other links—for instance, between child and adult outcomes—are treated only briefly, with pointers to the broader literature. In Part 2 we draw out some policy approaches to breaking the cycle at each point. This is an area where a “two-generation” approach may pay dividends. Specifically, we suggest policies to:

I. Reduce poverty;

II. Reduce the impact of poverty on depression among caregivers;

III...

We argue in Part 1 of this paper that maternal depression is an under-acknowledged factor in the intergenerational transmission of poverty, and lack of economic mobility. Specifically, we show that:

I. Poverty increases the risk of maternal depression;

II. Maternal depression can weaken attachment;

III. Weaker attachment can impair child development;

IV. Slower development can damage child outcomes; and

V. Worse child outcomes can increase the risk of future poverty.

Since our focus here is on the role of the mental health of caregivers in the very early years, we spend more time on these particular links in the chain. The other links—for instance, between child and adult outcomes—are treated only briefly, with pointers to the broader literature. In Part 2 we draw out some policy approaches to breaking the cycle at each point. This is an area where a “two-generation” approach may pay dividends. Specifically, we suggest policies to:

I. Reduce poverty;

II. Reduce the impact of poverty on depression among caregivers;

III. Reduce the impact of caregiver depression on early child development; and

IV. Reduce the impact of weaker early child development on later outcomes.